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28 Jul

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WORLD HEPATITIS DAY – July 28th 2013

The date of July 28 was chosen for World Hepatitis Day in order to mark the birthday of Professor Baruch Blumberg, awarded the Nobel Prize for his work in discovering the hepatitis B virus.
See no evil,hear no evil,as represented by the three wise monkeys, an old proverb that is commonly used to highlight how people often deal with problems by refusing to acknowledge them. The monkeys have been chosen for the campaign to highlight that around the world hepatitis is still being largely ignored.
Hepatitis simply means inflammation of the liver and can be caused by a wide range of things. One of the most common causes of chronic (long-term) hepatitis is viral infection.
Five distinct hepatitis viruses have been identified: A, B, C, D and E. Hepatitis B and C, which can lead to chronic hepatitis, are particularly prevalent.
The five hepatitis viruses have different epidemiological profiles and also vary in terms of their impact and duration. The transmission route depends on the type of virus. Transmission routes that contribute greatly to the spread of hepatitis are exposure to infected blood via blood transfusion or unsafe injection practices, consumption of contaminated food and drinking water, and transmission from mother to child during pregnancy and delivery. Unsafe injection practices, including the use of unsterile needles and syringes, serve as a major pathway for the spread of hepatitis B and C, and reducing transmission of both diseases means changing these practices.
Hepatitis B and C are two such viruses and together kill approximately one million people a year. 500 million people around the world are currently infected with chronic hepatitis B or C and one in three people have been exposed to one or both viruses. Unlike hepatitis C, hepatitis B can be prevented through effective vaccination.

It is estimated that around 180,000 are affected by hepatitis B in the UK. Around 95 per cent of people with new chronic hepatitis B are migrants, most of whom acquired the infection in early childhood in their country of birth.
Hepatitis C is also a blood-borne viral infection that is transmitted through contact with infected blood. Around 216,000 people in the UK have chronic hepatitis C, and of these 87 per cent are current or past injection drug users. Almost half of the rest are from South Asian descent.

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Together hepatitis B and C represent one of the major threats to global health. Hepatitis B and C are both ‘silent’ viruses, and because many people feel no symptoms, you could be infected for years without knowing it. If left untreated, both the hepatitis B and C viruses can lead to liver scarring (cirrhosis). If you have liver cirrhosis, you have a risk of life-threatening complications such as bleeding, ascites (accumulation of fluid in the abdominal cavity), coma, liver cancer, liver failure and death. In the case of chronic hepatitis B, liver cancer might even appear before you have developed cirrhosis.
Will Irving, Professor and Honorary Consultant in Virology, University of Nottingham and Nottingham University Hospitals NHS Trust, and member of the Programme Development Group, added: “It is estimated that around half of the individuals living in the UK with chronic hepatitis B or C infection are unaware of their diagnosis, but they are at risk of developing serious complications of their infection.

While there is a vaccine that protects against hepatitis B infection, there is no vaccine available for hepatitis C
Both viruses can be contracted though blood-to-blood contact
Hepatitis B is more infectious than hepatitis C and can also be spread through saliva, semen and vaginal fluid
In the case of hepatitis B, infection can occur through having unprotected sex with an infected person. Please note that this is much rarer in the case of hepatitis C
While unlikely, it is possible to contract hepatitis B through kissing. You cannot contract hepatitis C through kissing
Neither virus is easily spread through everyday contact. You cannot get infected with hepatitis B or C by shaking hands, coughing or sneezing, or by using the same toilet. There are different treatments for the two viruses. While treatment can control chronic hepatitis B, it can often cure hepatitis C
Even if treatment is not an option it is very important to maintain a healthy lifestyle. Alcohol, smoking, eating fatty foods, being overweight or extreme dieting (eating no food at all) may worsen liver disease.
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Hepatitis B

The World Health Organization (WHO) recognises that hepatitis B is one of the major diseases affecting mankind today. Hepatitis B is one of the most common viral infections in the world and the WHO estimates that two billion people have been infected with the hepatitis B virus and approximately 350 million people are living with chronic (lifelong) infections. 500,000 – 700,000 people die every year from hepatitis B.

It is part of our contract as doctors that we have to have been immunised for Hepatitis B and our immunity is checked by blood test. We also do the same for our nurse and phlebotomist.

The hepatitis B virus is highly infectious and about 50-100 times more infectious than HIV. In nine out of ten adults, acute hepatitis B infection will go away on its own in the first six months. However, if the virus becomes chronic, it may cause liver cirrhosis and liver cancer after up to 40 years, but in some cases as little as five years after diagnosis.

The hepatitis B virus is transmitted between people through contact with the blood or other body fluids (i.e. saliva, semen and vaginal fluid) of an infected person.It arises primarily from injecting drug use, heterosexual contact with someone who is infected, travel to countries of intermediate or high endemicity, homosexual contact, and contact with someone in the same household who is a carrier and mother-to-child transmission. Although not all people will have any signs of the virus, those that do may experience the following symptoms:

Flu-like symptoms
Fatigue
Nausea
Jaundice (yellowing of the skin)
Stomach ache
Diarrhoea/dark urine/bright stools
Aching joints
Unlike hepatitis C, there is a vaccine that can prevent infection. If you think you are at risk, you should get vaccinated as soon as possible.

Hepatitis C

Hepatitis C is different from hepatitis B in that the virus more frequently stays in the body for longer than six months, and therefore becomes chronic. Four out of five people develop a chronic infection, which may cause cirrhosis and liver cancer after 15–30 years. There are approximately 170 million people chronically infected with hepatitis C worldwide. In 2000, the WHO estimated that between three and four million people are newly infected every year.

Hepatitis C is mainly spread through blood-to-blood contact and, similarly to hepatitis B, there are often no symptoms but if they are present can include:

Flu-like symptoms
Fatigue
Nausea
Aching muscles and joints
Anxiety and depression
Poor concentration
Stomach ache
Loss of appetite
Dark urine/bright stools

Although this is considered a global problem we must be aware that this is on our doorstep and now when so many people travel throughout the globe it is imperative that travel immunisation is considered if you wanting to travel or in a high risk occupation.
In 2011 there were 160 reports of acute hepatitis B in London, a 13% increase from 141 in 2010. This corresponds to an incidence rate of 2.06 per 100,000 population, which is nearly twice the national rate (England rate 1.13 per 100,000) and nearly double that seen in any other region. The highest rates of acute hepatitis B infection were in Islington, Brent, Newham, Lambeth, Hackney and Tower Hamlets.
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Do you have concerns?
If you have any concerns regarding Hepatitis this can be screened in the practise by an ordinary blood test or it is possible to attend a GUM clinic on Level 8 at Ealing Hospital

GUM stands for genito-urinary medicine. The clinic can help you with any concerns you have about sexually transmitted infections (STIs).

It provides a walk-in and limited appointments based service. To make an appointment call (020) 8967 5555 during clinic opening times only.

Monday 9-11:30am Male and female walk-in
Five male appointments available
4-6:30pm Male and female walk-in
Five female appointments available

Tuesday 4-6pm 19 and under female walk-in

Wednesday 9-11:30am Female walk-in
2-4:30pm Male and female walk-in

Thursday 2-4:30pm Male and female walk-in

Please be aware that waiting times may vary, so please allow a minimum of one and a half hours for your visit.

Your results: Ealing GU clinic operates a no news is good news policy. We only contact you within two weeks of having your initial tests, if a result is positive. You can also get your results from the results line which is ONLY available during 9am-12pm on a Tuesday morning. You must have your clinic number to get your results.
More details are available on the following website
http://www.level-8.org/index.html
You can use this website to learn more about safer sex, infections or the services offered by the young women’s clinic.
GUM clinics are provided throughout the UK to find a clinic near you simply click on the following

http://www.nhs.uk/Service-Search/Sexual%20health%20information%20and%20support/LocationSearch/734

If you are concerned you may have had or you could be in contact with
Hepatitis B. Immunisation is available at the surgery, travel clinic or GUM clinic.
Travel clinics

http://www.travelvaccination.co.uk/?gclid=CJKwmZzP0bgCFXTJtAod-zQA9w
Our local clinic in Hounslow and Southall
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http://www.globetrotterstravelclinics.com/

Globetrotters Travel Clinics are one stop shops for all of your Travel Health needs. They provide Travel Health advice and services, as well as premium Travel Health Products.

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What does hepatitis B immunisation involve?

For full protection, you will need three injections of hepatitis B vaccine over four to six months.
You will have a blood test taken one month after the third dose to check the vaccinations have worked.
You should then be immune (resistant to the virus) for at least five years. You can have a booster injection five years after the initial injection.

Hepatitis B vaccine on the NHS
GP surgeries and sexual health or GUM clinics usually provide the hepatitis B vaccination free of charge if you are in an at risk group.
GPs are not obliged to provide the hepatitis jab on the NHS if you’re not thought to be at extra risk.
GPs may charge for the vaccine if you want it as a travel vaccine, or they may refer you to a travel clinic so you can get vaccinated privately. The current cost of the vaccine (in 2013) is around £30 a dose.

How safe is the hepatitis B vaccine?
The hepatitis B vaccine is very safe and other than some redness and soreness at the site of the injection, side effects from it are rare.
Read more about vaccine safety and side effects.

Emergency hepatitis B vaccination
If you’ve been exposed to the hepatitis B virus and have not been vaccinated before, you should immediately have the hepatitis B vaccine plus an injection of antibodies called specific hepatitis B immunoglobulin (HBIG). This is because the vaccine doesn’t work straight away. The immunoglobulin works immediately, albeit temporarily, so you’re protected until the vaccine starts to work.
Immunoglobulin should ideally be given within 48 hours, but you can still have the jab up to a week after exposure.

Babies and hepatitis B vaccination
Babies born to mothers infected with hepatitis B can be given a dose of the hepatitis B vaccine after they are born. This is followed by another two doses (with a month in between each) and a booster dose 12 months later.
Some babies also have an injection of immunoglobulin after they are born to help prevent infection.

HEPATITIS EFFECTS EVERYONE EVERYWHERE: KNOW IT CONFRONT IT AND PROTECT YOURSELF

“see no evil, hear no evil, speak no evil”

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